| Objective:To analyse the efficacy of entecavir(ETV) combined adefovir dipivoxil (ADV) and adefovir dipivoxil (ADV) combined lamivudine (LAM) in patients with lamivudine-resistant chronic HBV infection. Methods:Medline/Pumed. EMBASE, Cochrane were searched through May 10th,2013 to obtain relevant trials which met the inclusion criteria. Four eligible trials were included and evaluated methodologic quality and heterogennity. Review Manager Software 5.0 was used to analyse the data, serum HBV DNA reductions, HBV DNA undetective, ALT normalization, HBe Ag clearance and emergence rate of Virus breakthrough. Results:Four trials containing a total of 323 patients were included for the analysis. In the ETV+ADV group, Serum HBV DNA reductions after 3、6 and 12months of treatment were greater than that of LAM+ADV group[MD=0.90,95% CI:0.74-1.07, P<0.00001],[MD=0.96, 95% CI:0.37-1.56, P=0.002],[MD=1.34,95% CI:0.58-2.11, P=0.0006], respectively. For HBV DNA undetectable rate, the ETV+ ADVgroup was significantly higher than that of LAM and ADV (RR=1.63,95% CI: 1.14-2.34, P= 0.007). There were higher rates of serum ALT normalization in ETV+ADV group than those in LAM+ADV group after 6 months of treatment (RR=3.64,95% CI:1.32-10.02, P=0.01). The ETV+ADV group had lower viral breakthrough and genotypic mutation rates than LAM+ADV group after 12 months of treatment (RR=0.24,95% CI:0.10-0.58, P=0.002). Conclusions:ETV+ ADV combination therapy is superior to LAM add-on ADV in decreasing serum HBV DNA in lamivudine refractory patients with chronic hepatitis B, and had a lower rate of Virus breakthrough. |
PDF Full Text Request